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American Academy of Emergency Medicine

Fact of the Day - April 2012

Brought to you by the AAEM Resident & Student Association (AAEM/RSA)

April 30, 2012

The use of post-exposure prophylaxis presupposes that the person who was exposed to HIV is HIV-negative; thus, a negative result of a baseline enzyme-linked immunosorbent assay (ELISA) for antibodies to HIV should be documented concomitantly with the assessment for postexposure prophylaxis.

NEJM . Volume 361:1768-1775 October 29, 2009

April 29, 2012

Complications of SCFE, notably osteonecrosis of the head of the femur and chondrolysis (loss of articular cartilage) of the hip-joint (defined as joint width %2 mm), are associated with acute, unstable, and severe presentations.

Emerg Med Clin N Am 28 (2010) 85-102.

April 28, 2012

Studies of the limping child show that the cause is not always identified; no definitive diagnosis is made in up to 30% of cases.

Emerg Med Clin N Am 28 (2010) 85-102

April 27, 2012

An intra-compartmental pressure greater than 30 mmHg and a calculated difference between the diastolic blood pressure and intra-compartmental pressure less than 30 mmHg both suggestive of compartmental syndrome with sensitivity ofgreater than 80%.

Emerg Med Clin N Am 28 (2010) 85-102

April 26, 2012

In pediatric patients who have a limp, the prone position is optimal for examination, which allows uncoupling of the knee from the hip, in which the pathology of one may masquerade as the other.

Emerg Med Clin N Am 28 (2010) 85-102

April 25, 2012

With supracondylar fractures, neural injury occurs in approximately 10% to 15% of cases with recovery in up to 6 months and therefore does not require immediate surgery.

Emerg Med Clin N Am 28 (2010) 85-102

April 24, 2012

Although a prior negative angiogram may be helpful in risk stratification in a chest pain patient with a compelling history or in a high-risk clinical situation, it cannot be used alone to discharge a patient without further testing.

Emerg Med Clin N Am 28 (2010) 183-201.

April 23, 2012

ECG represents a single snapshot in the patient's presentation and may be normal or non-diagnostic even in the face of active ischemia.

Emerg Med Clin N Am 28 (2010) 183-201.

April 22, 2012

Approximately 50% of patients with unstable angina and non-Q-wave MI do not have significant abnormalities on ECG.

Emerg Med Clin N Am 28 (2010) 183-201.

April 21, 2012

More than 35 million people worldwide — 5.5 million in the United States — have Alzheimer's disease, a deterioration of memory and other cognitive domains that leads to death within 3 to 9 years after diagnosis.

NEJM Volume 362:329-344 January 28, 2010

April 20, 2012

The most common symptom of cardiac ischemia in thosegreater than 85 years is dyspnea. Other common presentations are fatigue, lightheadedness, worsening CHF, syncope, and altered mental status.

EBMedicine.net. Janurary 2010.

April 19, 2012

Vigorous hydration with normal saline is indicated to manage hypercalcemia as it replenishes intravascular volume, dilutes the serum calcium, and enhances renal calcium excretion. If calcium levels remain elevated after volume repletion, administering furosemide to enhance calciuresis is recommended.

N Engl J Med 2011; 364:552-562

April 18, 2012

Chest-pain relief with either nitroglycerine or GI cocktail does nothing to improve the diagnostic accuracy for ACS and should not be used to influence decision making.

Emerg Med Clin N Am 28 (2010) 183-201

April 17, 2012

The greatest pitfall for the emergency physician in evaluating a patient with ACS in the absence of chest pain is failing to consider the diagnosis of cardiacischemia entirely.

Emerg Med Clin N Am 28 (2010) 183-201

April 16, 2012

With moderately elevated calcium levels (12.0 to 13.5 mg per deciliter [3.0 to 3.4 mmol per liter]), weakness, anorexia, constipation, polyuria and polydipsia due to intravascular volume contraction usually develop.

N Engl J Med 2011; 364:552-562.

April 15, 2012

Poststreptococcal glomerulonephritis does not appear to be prevented by antibiotic treatment of streptococcal pharyngitis.

N Engl J Med 2011; 364:648-655

April 14, 2012

The most predictive risk factor for cardiac ischemia is a past medical history of CAD.

EBMedicine.net. January 2010.

April 13, 2012

According to the Rapid Early Action for Coronary Treatment (REACT) study, patients with chest pain do not seek timely care for the following reasons:

  • A lack of knowledge about symptoms, especially atypical or minor symptoms
  • A wait-and-see attitude that assumes the pain is self- limiting and will go away
  • A false assessment of personal risk factors
  • A lack of knowledge about the importance of rapid and timely interventions
  • The fear of causing a false alarm

EBMedicine.net,January 2010.

April 12, 2012

The failed airway in emergency management has been defined as (1) inability to maintain adequate oxygenation following a failed intubation attempt; or (2) three failedattempts at intubation by an experienced provider, even if oxygenation can be maintained.

Lippincott ,Williams & Wilkins; 2008. p. 81-93.

April 11, 2012

Penicillin V, benzathine penicillin G, and amoxicillin are each recommended for the treatment of streptococcal pharyngitis, however, Benzathine penicillin G has the best evidence for the prevention of acute rheumatic fever and obviates concerns about patient adherence.

N Engl J Med 2011; 364:648-655

April 10, 2012

The mainstay of treatment of Rhabdomyolysis is early, aggressive fluid resuscitation with NS at a rate of approximately 400 ml/hr (200 - 1000 ml/hr depending upon setting and severity) with a target urine output of 3 ml/kg (200 ml/hr).

NEJM. 2009;361(1):62-72.

April 09, 2012

First-attempt failure during RSI in the ED occurs about 10% to 23% of the time, the need for more than 2 attempts is about 3%, and the failure rate for RSI in the ED is approximately 1%.

Annals of Emerg Med;43:48-53.

April 08, 2012

Group A streptococcus (Streptococcus pyogenes) is responsible for 5 to 15% of cases of pharyngitis in adults and 20 to 30% of cases in children and occurs most commonly among children between 5 and 15 years of age.

N Engl J Med 2011; 364:648-655

April 07, 2012

There are three main areas of management of a variceal hemorrhage: primary prophylaxis to prevent a first episode of variceal hemorrhage, treatment of the acute bleeding episode, and secondary prophylaxis (prevention of recurrent variceal hemorrhage).

NEJM . Volume 362:823-832 March 4, 2010

April 06, 2012

For assessing patients with trauma for pneumothorax, ultrasonography has been shown to be more than twice as sensitive as conventional supine chest radiography for detecting occult pneumothorax (pneumothorax seen only on CT), with similarly high specificity (>98%).

N Engl J Med 2011; 364:749-757

April 05, 2012

A study comparing Dopamine and Norepinephrine in the treatment of shock showed that the use of dopamine was associated with a greater number of adverse events despite the insignificant difference in the rate of death between patients with shock who were treated with dopamine versus norepinephrine.

NEJM Volume 362:779-789 March 4, 2010

April 04, 2012

Ventricular fibrillation and sudden death triggered by a blunt, non-penetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (and in the absence of underlying cardiovascular disease) constitute an event known as commotio cordis, which translates from the Latin as agitation of the heart.

NEJM Volume 362:917-927 March 11, 2010

April 03, 2012

QT prolongation is considered to occur when the QTc interval is greater than 440 milliseconds in men and 460 milliseconds in women, with arrhythmias most commonly associated with values greater than 500 milliseconds.

Emerg Med Clin N Am 25 (2008) 715-739

April 02, 2012

A FAST examination may be completed in less than 5 minutes and has been shown to have a sensitivity of 73 to 99%, a specificity of 94 to 98%, and an overall accuracy of 90 to 98% for clinically significant intraabdominal injury in trauma.

N Engl J Med 2011; 364:749-757

April 01, 2012

The e-FAST examination combines five focused examinations for the detection of: free intraperitoneal fluid, free fluid in the pelvis, pericardial fluid, pleural effusion, and pneumothorax.

N Engl J Med 2011; 364:749-757